05795 (SFD)Building
Address 78-170 IKIRTMA.
Tit4t
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
AM CONSTRUCTION
Mailing
Address P.O. BOX 366
City Zip Tel.
1AgUINTA 192253 54-483
Contractor
Address
City lZip I Tel.
State Lic.I City
& Classif. 48758 Lic. # 653
Arch., Engr.,
Designer
Address Tel.
City (Zip (State I
Lic. #
LICENSED CONTRACTOWS DECLARATION
I hereby affirm that I am license4.under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Businesvand.Professioms Code, alicense is in full force and
effect. A �. '— ""-
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Caw does not apply to an owner of property who
bulls or improves thereon and who does such work himself or through hts own employees,
provided that such improvements are not intended or offered for sale. ff. however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose or sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
11
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate�.ff'consent to.selfynsure„or a certificate of
Workers Compensation Insurance, or a certifieyyd:copyRhereof. (Sec. @OOH aWr Code.)
Policy No. Company I
O.Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date owner
NOTICE TO APPLICANT: n, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I=firm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-:
mentioned property for inspection purposes.
Signature of appliwnL_ Date
Mailing Address
City, State, zip
01
No.
BUILDING: TYPE CONST. OCC: GRP..
A.P. Number 769--104-103
Legal Description LOT 3
Project Descriptiong • f • 4s
05795
Sq. Ft. 2226
Size
No. Dw.
Stories
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$125,221.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
359.77
Const.
730.50
Mech.
53.50
Electrical
138.87
Plumbing
257.50
S.M.I.
8.83
Grading
20.00
Driveway Enc.
20.00
Infrastructure
2,673.53
MME PLAN
25-00
TOTAL
REMARKS
V05 MAW,) #ai•XMi - ' - t 62,tO I
ZONE: BY:
Minimum Setback Distances: .
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 529/89Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
GAR. SQ, FT, ®
POWER OUTLET
ROOF DRAINS
METER LOOP
DRAINAGE PIPING
CAR P. I SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING�p
MESH
INSULATIONISOUND
FINISH GRADING CCC
FINAL INSPECTION
CERT. OCC.
FFr.I(:F FINAI
LAUNDRY TRAY
AIR HANDLING UNIT CFM
v!
J
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEETi��
ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLU
NGZ G UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
y
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR. FINAL INSP.
FRAMING 7 FINAL INSP.
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING�p
MESH
INSULATIONISOUND
FINISH GRADING CCC
FINAL INSPECTION
CERT. OCC.
FFr.I(:F FINAI
6
L
v!
J
REMARKS:
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
0.� Q
SCHOOL FACITY.• FEES
4-11
T0: City of La Quinta,E�'yy� E:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253.�,��
This is to cer ify that+
developer of ,�;, which is
located at within
this District, has paid school facility fees imposed pursuant to the
authority generate by Government ode ecti st 53080 in t e amo t of
covering a total ofd :sqpWfeet of ( ) re idential or
industrial/commercial developmend that building permits for
this footage in this development may n w be issued by your jurisdiction.
or SERT SANDS UNIFIED SC L DISTRICT
ND �.
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
PLANNING CORRECTIONS:
1. School fee
78-170 FORTUNA ,
5/19/89
1 11111,
y, v t.t .4 d' ^Nk • Wit( ".III
k w
n
Z
O
U
W
V)
T
COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH Assessors ftmel No.
�t8 — 603
ENVIRONMENTAL HEALTH SERVICES
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check list
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval.
VERIFY ITEMS IN SECTION A FROM BUILDING 8 SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG' i
Agent Cont or tact49 ` r-
�ne
Address 8 Phor-d 7- L
)
YQ3
O
5;V
Owner , l ,
Phone
Mailing Address 3
City
to
Job Property Address
�e//C ti16)vti/16
Legal Description Prop. (PM, Tract Lot)
Lot Size
Water Agency/Well
Use of Permit P/P, CU, etc.
Other
lti�
c v,
.10two
Dwelling, MH Site Prep, etc.
5"1- 07
Signature of Applicant
D
CATEGORY: REV CODE FEE
/SUBSURFACE
CATEGORY: REV CODE FEE
DISPOSAL 1238 $45.00
❑ SITE EVALUATION UPON REQUEST 7349 $42.00
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION J
❑ SEWER/SEPTIC VERIFICATION 7348 $11.00
a. 1 at 4 Parcels (Each) 1238 $45.00
(Less than 1 year)
b. Each Parcel after 4 7344 $16.00
❑ PRELIMINARY ELECTIVE 7352 $45.00
❑ Rereview (2nd review same parcel) 7344 $16.00
EVALUATION (Attach DOH SAN 53)
❑ Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $45.00
Critical Area 7346 $86.00
❑ ALTERNATIVE/EXPERIMENTAL 7345 $13200
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $86.00
INITIAL DATE
Holding Tank Agreements Completed, ❑ Yes V No 9 S r
Certification of Existing S.D. System Required ❑ Yes I No ~
WQCB Clearance required. (Attach Form ❑ Yes I No
DOH SAN 007, Santa Ana Region Only)
Sills Percolation Report Required. ❑ Yes No
Special Feasibillty Boring Report Required. ❑ Yes No
Detailed Contour Plot Plans Required (1 to 5 }t interval) ❑ Yes No
Other �.. ❑ Yes NO
Staff Specialist Lot Inspection Required ❑ Yes No
lot Inspection Date
_
r//` —
Solis boring report by project # Date
i�
Solis Map Page Son Type Approved by Dame
No. of Syslsrtra
Type of By tem(s)
Dwelling Units
ank
(1) Septic TG-
Soil Rate
Grease/Sand
❑ UoWing Tank ❑ Existing
'��(�eka ° Replacement
Fixture Unita
%
Grease IMop
3 vT yt
/ b (s
y- / g
W
(
Gel
(2) LeachLhe Sq.F
Sidewall al
install Line(s) -R long R wide with
Leach Bed sq. i t
Bottom trench
/
R rock/ sq. R
per Hing R
min. c below dnrfnlines or
of
❑ . NA
' for or slope:
Leachlines/bed spzrde0nesf%."
Applicable
(3) Pit Diameter
/
No. Pita
Pit Below
Inlet (BI)
Seepage Pit Total Depth
N 3 '
Other.
Max. Allowable Depth
`!3'
N/A
° 5 � 6
ONc
L0
No. 2 System
REMARKS: � 17- vA/0
r 414,1
. - att--'"-F"'a.:. rn.- ....'k%A .+1a fir,-: u., r ..•..rte+ -r.— e.. ^'m•+—. r ., y .--}, �. .-.,q....r•.i.. Y�...� ..- __
This applicat' is APPROVE ENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction is permitted in the required reserved 100% expansion area.
Septic tank and sewer lines must be 50' minimum from any wells
( Leach lines must be 100' minimum from any wells, including expansion area
Seepage pits must be 150'' from any wells, including expansion area
/`-�minimum
G
Signature of Health Official 1`itt�z Date P9
RECEIPT NO. 6 ! Issued By e Date 6ZI D
( DISTRICT: ❑ Riverside, Indio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe
DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records